Dementia prevention starts in middle age: expert

Middle age is where the fight to prevent Alzheimer's dementia should begin, a world-leading dementia expert says.

After more than 15 years and billions of dollars spent on failed drug trials targeting late-stage Alzheimer's, researchers were looking upstream to prevention that began in midlife, said Craig Ritchie, Professor of Psychiatry and Ageing at the University of Edinburgh.

Craig Ritchie, head of PREVENT Project and Professor of Psychiatry and Ageing at the University of Edinburgh.

“Alzheimer's disease has its genesis in your 50s, 40s, even earlier,” said the lead researcher of the PREVENT project, a major international consortium working towards identifying early dementia risk factors.

He drew a clear distinction between Alzheimer's dementia and Alzheimer's disease.

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“Alzheimer’s dementia is the final end point,” Professor Ritchie said, culminating in disorienting forgetfulness and confusion, a loss of self and independence, and death, he told the International Dementia Conference hosted by Hammondcare in Sydney this week.

Alzheimer's disease encompassed the changes and pathologies that built up in the brain over decades, long before symptoms of dementia emerged.

“But if you detect Alzheimer's disease in its earliest stages, who’s to say you can’t cure that?”

Roughly 424,000 people are living with dementia in Australia; the second leading cause of death nationally, according to the Australian Bureau of Statistics.

In 2017, the Lancet Commission released a life-course model for dementia risk that stretched from a person's genetic risk at birth, to early life education level; middle-age hearing loss, hypertension, and obesity; and late-life smoking, depression, physical inactivity, social isolation and diabetes.

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"The evidence we’re seeing now suggests that decisions you make in mid-life can impact your chances of getting dementia, as well as your brain health after diagnosis,” he said.

“What’s good for your heart is good for your head."

Cardiovascular health promoted good brain health by maintaining good oxygen and nutrient supply to the brain, Professor Ritchie said.

Healthy habits around exercise, weight control, eating a balanced diet and not smoking from an early age could help slow the progression of dementia over decades, he said.

Taking on new cognitive challenges that kept the brain active was also likely to be protective.

“We should try to learn new things throughout our lives, but this tends to drop off once you start working,” Professor Ritchie said.

Crosswords weren’t enough for people who had done crosswords for years.

“If you don’t play a musical instrument, now is the time to pick up the guitar or start playing the piano,” he said.

Depression and anxiety appeared to be strongly associated with dementia, Professor Ritchie said.

“We need to try to find a way to help people remain socially connected.”

“Your brain lights up more when you’re having a conversation than if you were doing a crossword on your own.”

But there were no guarantees an individual would avoid dementia by following this advice, Professor Ritchie said.

“If we were advocating something expensive and harmful, then we would need a much stronger evidence base.”

None of the recommendations were harmful, and each was known to improve general health, “so why not try them?” he said.

The greatest challenge for dementia researchers was trying to understand why the disease first forms and why it progresses when people in the early stages show no symptoms, Professor Ritchie said.

Alzheimer's scientists can’t biopsy the brains of research subjects. Instead they rely on identifying biomarkers.

Professor Ritchie and his colleagues have recruited thousands of volunteers who undergo neuroimaging, cognitive testing, even lumbar puncture in the service of Alzheimer's research.

“The question then becomes how do you translate this to the general public?”

“Now is not the time for screening for [early stage] Alzheimer's disease,” Professor Ritchie said. “We don’t have any good treatments or interventions that would make a difference to this course of illness.”

Future drug treatments would be part of the solution but not the only solution, Professor Ritchie said.

Eventually Professor Ritchie would like to see brain health clinics established that would conduct risk profiling and give individuals personalised dementia prevention plans.

“We’d ideally like to come up with a risk score and we’re working on that at the moment."

Professor Ritchie said there would never be a breakthrough in dementia research. Progress will be so gradual it will be almost imperceptible.